Free Letter - District Court of Delaware - Delaware

Case 1 :05-cv—00037-SLR Document 22-2 Filed 09/13/2005 Page1 of4 `
Delaware Department of Correction
Health Care Services Fee Sheet
Inmate Name SBI #
(Last, First Ml)
Facility S Date
_+ Chargeable Visit $4,00
_ Non Chargeable Visit -0-
__ Medication Handling Fee ($2.00 X ) S
Total Amount Charged To Inmate Account S
Health Care Staff Signature:
I CERTIFY BY MY SIGNATURE THAT I HAVE RECEIVED THE SERVICES
I DESCRIBED ABOVE.
V Inmate Signature: rd" . ,. Date:
1) "‘Witness Signature: Date:
2) *Witness Signature: Date:
The fee for services rendered will be deducted from your inmate account even if the amount
deducted generates a negative balance. Any funds received by you will lirst be applied to any
negative balance. Any negative balance remaining on your account when you are released will
remain active for three (3) years after the date of release. Should you return to Delaware Department
of Correction as an inmate within that three (3) year period. the negative balance will be applied to
your inmate account on your new commitment.
Distribution:
Original: Facility Business Office Posted/Entered by Dale
Copy: Inmate Medical Record (yellow)
Inmate (pink)
*Only needed ifinmate refuses or is unable to sign.
FORM #: 621 I I
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(C:(‘opay96:Form.4)

Case 1:05-cv-00037-SLR Document 22-2 Filed 09/13/2005 Page 2 of 4
STATE OF DELAWARE
DEPARTMENT OF CORRECTION
OFFICE OF THE WARDEN
DELAWARE CORRECTIONAL CENTER
1181 Paddock Road
SMYRNA, DELAWARE 19977
Telephone: (302) 653-9261
Fax: (302) 653-2855
MEMORANDUM
TO: Inmate Harry Samuel
#201360
FROM: Thomas L. Carroll 7 L
Warden L7 ’ I I
DATE: November 20, 2001
RE: Letter
This will acknowledge receipt of your letter on November 15, 2001 regarding
dental problems. Please be advised that this matter has been fon/varded to Ms. Georgia
Perdue of Correctional Medical Services for her information, review and action.
TLC/sw
Cc: Georgia Perdue, CMS
file

Case 1:05-cv-00037-SLR Document 22-2 Filed 09/13/2005 Page 3 of 4 .
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STATE OF DELAWARE .
DEPARTMENT OF CORRECTION
OFFICE OF THE WARDEN ~
DELAWARE CORRECTIONAL CENTER
1181 Paddock Road
SMYRNA, DELAWARE 19977 -
Telephone: (302) 653-9261
Fax: (302) 653-2855
MEMORANDUM
ro:
#201360
FROM: Thomas L. Carroll [ -
Warden - / '
DATE: October 26, 2001
RE: Letter
This will acknowledge receipt of your letter dated October 19, 2001 regarding
dental services. Beadvised that I have forwarded your request to Ms. Georgia Perdue
of Correctional Medical Services for action.
TLC/sw U
Cc: Deputy Warden McGuigan
Security Superintendent Cunningham
Georgia Perdue
file

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DEPARTMENT OF CORRECTION
STATE OF DELAWARE
Qrif MEMO TO INMATE
TO: » Samuel, Harry MHU2l, B9L
DATE: 9/24/04
FROM: Counselor Linda Kemp /QOL/’~
SUBJECT: AVP · ‘
Your name will now be placed on the list for AVP #3 and you will
be notified, in writing, when to attend. However, due to staff
shortages on the weekend we are on hold until further notice. I
would like to think we might start up again in January 2005. _
Please be patient as it is out of our control. `
Unless you are court-ordered to complete AVP, the program is
strictly volunteer and you can stop whenever you want. I would
hope that you got something out of the first two and would choose
to continue but that is entirely up to you. I will have you put on
the next list but when you are called, if you so choose not to
continue then just decline. Thanks for your previous interest in
AVP.
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